Anatomy and Physiology Lecture Notes

Unit 7 – Circulatory System - The Heart

Approximately the size of a person's fist, the hollow, cone-shaped heart

weighs less than a pound. The pointed apex is pointed toward the left hip
and rests on the diaphragm, approximately at the level of the
fifth intercostal space. Its broader posterosuperior aspect, the base, from
which the great vessels of the body emerge, points toward the right
shoulder and lies
beneath the
second rib.

The human
heart essentially
is two separate
hearts enclosed
in a membrane
called the pericardium. The pericardium surrounds the heart and secretes
a fluid that reduces friction as the heart beats. Fibrous tissues in the
pericardium protect the heart and anchor it to surrounding structures, such
as the diaphragm and sternum.
The heart walls are composed of three layers:
 The epicardium, or visceral pericardium, is actually part of the pericardium.
 The myocardium consists of thick bundles of cardiac muscle, the layer that
actually contracts.
 The endocardium is a thin, glistening sheet of endothelium that lines the
heart chambers and helps blood flow smoothly through the heart. It is
continuous with the linings of the blood vessels leaving and entering the heart.
The upper chambers of the heart, right and left atria (atrium), receive
blood returning to the heart. As a rule, they are not important in the
pumping activity of the heart. Blood flows into the atria under
low presure from the veins and then continues on to fill the ventricles.
The lower chambers, right and left ventricles, pump blood out of the
heart. The left ventricle is the thickest chamber of the heart because it has
to do most of the work to pump blood to all parts of the body.
Vertically dividing the right and left sides of the heart is a common wall
called the septum. The septum prevents the mixing of oxygen-poor and
oxygen-rich blood.
Circulation Through the Heart
Pulmonary Circulation: Systemic Circulation:
The right side of the heart pumps blood The left side of the heart pumps oxygen-
from the body into the lungs, where oxygen- rich blood (oxygenated), from the lungs to
poor blood (deoxygenated), gives up the rest of the body except the lungs.
CO2 and picks up O2.

 Oxygen-poor blood from the body
enters the right side of the heart
through two large blood vessels.
 The superior (upper) vena
cava brings blood from the
upper part of the body to the
heart.
 The inferior (lower) vena
cava brings blood from the
lower part of the body to the
heart.
 Both vena cava empty into the right
atrium. When the heart relaxes
(between beats), pressure in the
circulatory system causes the atrium
to fill with blood.
 When the heart contracts, blood is
squeezed from the right atrium into
the right ventricle through flaps of
tissue called
the atrioventricular (AV) valve,
that prevents blood from flowing
back into the right atrium.
 The valve that separates the right
atrium and ventricle is called
the tricuspid valve.
 The general purpose of all valves
in the circulatory system is to
prevent the backflow of blood.
They also ensure that blood flows
in only one direction.
 The specific purpose of the tricuspid
valve is to prevent backflow of
blood from the right ventricle to the
right atrium when the right ventricle
 Oxygen-rich blood leaves the lungs
and returns to the heart by way of
blood vessels called pulmonary
veins. These are the only veins to
carry oxygen-rich blood.
 Returning blood enters the left
atrium, it passes through flaps of
tissue called
the atrioventricular (AV) valveto
the left ventricle.
 The valve that separates the left
atrium and ventricle is called
the mitral valve or biscuspid valve.
 From the left ventricle, blood is
pumped through a semilunar valve
called the aortic valve into
the aorta artery that carries blood
to every part of the body except the
lungs.
 At the base of the aorta is an aortic
valve that prevents blood from
flowing back into the left ventricle.
 contracts.
 When the heart contracts a second
time, blood in the right ventricle is
sent through a semilunar (SL) valve
known as the pulmonary valve into
the pulmonary arteries to the
lungs. These are the only arteries to
carry oxygen-poor blood. At the
base of the pulmonary arteries, the
pulmonary valve prevents blood
from traveling back into the right
ventricle.

The Heart Valves

The two artioventricular valves prevent backflow into the atria
when the ventricles contract:
 The left AV-valve, the biscupid or mitral valve consists
of two cusps, or flaps, of endocardium.
 The right AV-valve, the tricuspid valve has three cusps.
The two semilunar valves close the two large arteries as the
ventricles relax:
 The right SL-valve, the aortic valve has three cusps that
fit tightly together.
 The left SL-valve, the pulmonary valve also has three
cusps.

The cardiac cycle is the sequence of events in one heartbeat.

In its simplest form, the cardiac cycle is the simultaneous contraction of the
two atria, followed a fraction of a second latter by the simultaneous
contraction of the two ventricles.
A heartbeat has two phases:
 Phase 1 - systole - contraction.
Occurs when the ventricles contract, closing the AV valves and
opening the SL valves to pump blood into two major vessels leaving
the heart.
 Phase 2 - diastole - relaxation.
Occurs when the ventricles relax, allowing the back pressure of the blood
to closed SL valves and opening AV valves. The cardiac cycle also creates
the heart sounds:
Each heartbeat produces two sounds, often called lubb-dub, that can be
heard with a stethoscope.
 The first sound, the loudest and longest, is caused by the ventricular systole
(contraction) closing the AV valves.
  The second sound is caused by the closure of the aortic and pulmonary
valves (SL).
If any of the valves do not close properly, an extra sound called
a heart murmur, may be heard.
Heart Muscle Contraction:
The heart consists of muscle cells that contract in waves. When the first
group is stimulated, they in turn stimulate neighboring cells. Those cells
stimulate more cells. This chain reaction continues until all cells contract.
The wave of activity spreads in such a way that the atria and the ventricles
contract in a steady rhythm.
The wave begins in a small bundle of specialized heart muscle cells
embedded in the right atrium called the sinoatrial node (SA). The SA-
node is the natural pacemaker of the heart. It initiates each heartbeat,
without stimulation from the nervous system, and sets the pace for the
heart rate.
The impulse spreads from the pacemaker through the cardiac muscle cells
in the right and left atrium, causing both atria to contract almost
simultaneously. When the impulse initiated by the SA-node reaches
another special area of the heart known as the atrioventricular (AV) node.
The AV-node is located in the septum between the right and left ventricles.
The AV-node relays the electrical impulse to the muscle cells that make up
the ventricles. The ventricles contract almost simultaneously a fraction of a
second after the atria, completing one full heartbeat. These contractions
causes the chambers to squeeze the blood, pushing it in the proper
direction along its path.
Cardiac Output (CO) is the amount of blood pumped out of each side of
the heart (each ventricle) in 1 minute. It is the product of the heart rate (HR)
and the stroke volume (SV). Stroke volume is the volume of blood
pumped out by a ventricle with each heartbeat. In general, stroke volume
increases as the force of ventricular contraction increases.
Using the normal resting values for heart rate (75 beats per minute) and
stroke volume (70 ml - about 2 ounces - per beat), the average adult
cardiac output can be easily figured.

CO = HR X SV
CO = (75 beats / min) ( 70 ml / beat)
CO = 5250 ml / min
Regulating Stroke Volume:
A healthy heart pumps out about 60% of the blood that enters it. The critical
factor controlling stroke volume is how much cardiac muscle cells are
stretched just before they contract. Venous return, the amount of blood
entering the heart and distending its ventricles, is the determining factor.
Anything that increases the volume or speed of venous return also
increases stroke volume and force of contraction.
 A slow heartbeat allows more time for the ventricles to fill.
  Exercise speeds venous return because it results in increased heart rate and
force.
 The enhanced squeezing action of active skeletal muscles on veins returning
blood to the heart, the so-called muscular pump, also plays a major role in
increasing benous return.
On the other hand, low venous return, such as might result from sever
blood loss or an extremely rapid heart rate, decreases stroke volume,
causing the heart to beat less forcefully.
Regulating Heart Rate:
For most of us, at rest our heart beats between 60 and 80 beats per
minute. Under certain conditions, that number can increase to as many as
200 beats per minute.
 The sympathetic nervous system increases heart rate.
During times of physical or emptional stress, the SA-node and AV-
node - and even the cardiac muscle itself - can be stimulated to
increase heart rate.
 The parasympathetic nervous system decreases it.
When demand declines, the vagus nerves slow and steady the heart.
 Various hormones and ions can have a dramatic effect on heart rate.
Epinephrine, which mimics the effect of the sympathetic nerves,
and thyroxine both increase heart rate.
Reduced Ca+2 in the blood depresses the heart, while a low level of
K+ causes the heart to beat feebly and without rhythm.
 A number of physical factors, including age, gender, exercise, and body
temperature, influence heart rate.
Cardiac Circulation:
Although the heart chambers are continuously bathed with blood, the
blood contained in the heart does not nourish the myocardium. The blood
supply that oxygenates and nourishes the heart is provided by the right and
left coronary arteries. The coronary arteries branch from the base of the
aorta and encircle the heart in the atrioventricular groove at the junction of
the atria and ventricles. The coronary arteries and their major branches are
compressed when the ventricles are contracting and fill when the heart is
relaxed. The myocardium is drained by several cardiac veins, which
empty into an enlarged vessel on the backside of the heart called
the coronary sinus. The coronary sinus, in turn, empties into the right
atrium.
Heart-related Problems:
Pericarditis is an inflammation of the pericardium. This can lead to a
decrease in the amount of serous fluid surrounding the heart, which in turn
causes the pericardial layers to bind and stick together, forming painful
adhesions that interfere with heart movements.
Heart valves are basically simple devices, and the heart - like any
mechanical pump - can function with "leaky" valves as long as the damage
is not too great. However, severe valve deformities can seriously hamper
cardiac function.
 An incompetent valve forces the heart to pump and repump the same blood
because the valve does not close properly and blood backflows.
 In valvular stenosis, the valve flaps become stiff, often because of repeated
bacterial infection of the endocardium (endocarditis). This forces the heart to
contract more vigorously than normal.

In each case above, the heart's workload increases, and ultimately the heart
weakens and may fail. Under such conditions, the faulty valve can be
replaced with a synthetic valve, or a valve taken from a pig heart.
Angian pectoris is a crushing chest pain caused by low levels of oxygen
reaching the myocardium. While the cause of this decreased flow to the
heart tissue may vary, the pain is a warning that should never be ignored.
Prolonged angina may cause the death of ischemic (blood-starved) heart
cells, forming an infarct. The resulting myocardial infarction is commonly
called a "heart attack" or "coronary".
Fibrillation is a rapid uncoordinated shuddering of the heart muscle. This
contraction of the heart muscle is described as looking like a "bag of
worms". The cause is related to either or both of the heart "nodes" and
makes the heart totally useless as a pump. This is th major cause of death
from heart attacks in adults.
Tachycardia is a rapid heart rate (over 100 beats per
minute). Bradycardia is a heart rate that is substantially slower than
normal (less than 60 beats per minute). Neither condition is pathological,
but prolonged tachycardia may progress to fibrillation.
Congestive heart failure (CHF) is a progressive decrease in the efficiency
of the heart. This condition reflects a weakening of the heart by
coronary artherosclerosis (clogging of the coronary vessels with fatty
buildup), persistent high blood pressure, or multiple myocardial infarcts -
leading to repair with non-contracting scar tissue.
Pulmonary congestion occurs when only the left side of the heart fails.
The right side of the heart continues to pump blood to the lungs, but the left
side is unable to send the returning blood into the systemic circulation. As
blood vessels within the lungs become swollen with blood, the pressure
causes leaking into the lung tissue, causing pulmonary edema (lung
swelling).
Peripheral congestion occurs when only the right side of the heart fails,
causing blood to back up in the systemic system. Edema is most noticeable
in the distal parts of the body - the feet, ankles, and fingers become swollen
and puffy. Failure of one side of the heart puts a greater strain on the
opposite side, and eventually the whole heart fails.